What to know about Autism Spectrum Disorder (ASD)

In diversity there is beauty and there is strength. Ignorance is the tragedy, find out more about Autism Spectrum Disorder as below :

Q: What is Autism Spectrum Disorder (ASD) ?

Autism Spectrum Disorder is a single disorder described in the recently released fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The diagnostic category no longer includes separate diagnoses for Asperger’s Syndrome and Pervasive Developmental Disorder-Not Otherwise Specified. The DSM-5 also includes a related, but distinct, diagnostic category of Social Communication Disorder. (source: Association for Science in Autism Treatment - asatonline.org)


Q: What are the symptoms of ASD?

Individuals with ASD exhibit three major symptoms:

· Qualitative Impairments in Communication

Impairments in communication include both verbal and nonverbal deficits. Individuals with ASD presents poorly developed language, and often stereotyped language, in which they are unusually repetitive (i.e., repeating phrases or words heard from advertisements or TV program over and over), or have absence of speech. Other unique features are echolalia (rote repetition of what has been heard, or parroting), pronoun reversal (confusion in referring self in second or third person), verbal preservation (repeating certain phrases over and over, or dwelling on a single topic), and abnormalities of prosody (rate, rhythm, inflection, or volume of speech).


In some cases, individuals with ASD initially developed some language but showed a loss in language or regression, usually during the second year. On the other hand, some has significant delay in all aspects of language and communication.


· Qualitative Impairments in Social Interaction

Individuals with ASD are described as "aloof", "unresponsive", and "in their own world". They have significant deficits in relating to others and often, do not use gestures, such as pointing and shaking or nodding their heads, fail to respond to their name, avoid eye contact, and have difficulty interpreting what others are thinking or feeling.


Parents have reported that they have first notice the symptoms since infancy, as they find their child have poor eye contact, lack interest in being held, or stiffens when held. As they grow older, these children may express their social impairment by ignoring people or interacting only to have their needs met. And older or higher functioning children may desire social relationships but is insensitive to others' reactions, and has difficulty picking up social cues.


· Restricted Repetitive and Stereotyped Patterns of Behavior, Interest and Activities

Many ASD individuals engage in repetitive movements such as rocking, spinning, flapping their hands, or in self-abusive behavior such as head-banging and biting. They also very narrow interests, for instance, lining up cars, building towers, and sorting out CDs in colors. In terms of activities, they have a tendency to be preoccupied with parts of objects such as the wheels of a car, or shiny objects.


Q : Is ASD inherited?

A few medical conditions has been found to occasionally give rise to ASD, These include genetic disorders such as tuberous sclerosis, fragile X Syndrome, and phenylketonuria. However, there is still no single case of identifiable medical disorder found to explain ASD. Recent studies have also shown that ASD may run in families. About 3% of siblings of a child with autism also develop autism (Piven and Folstein, 1994). This is greater than the risk for the general population, and researchers are looking for clues about which genes contribute to this increased susceptibility.


In short, there are studies that show strong relations between ASD and the role of genetics. But, efforts are still in the process to determine the gene responsible for ASD.


Q: Can ASD be cured?

There are no medications to 'cure' ASD and research is still on-going particularly in psychotropic (mood-altering) medications that may treat the symptoms. On the other hand, various research-based interventions have shown promise in improving some symptoms of ASD individuals.


Q: What kind of therapy is available to treat ASD?

Several studies have shown that treatment approach using the methods in Applied Behavioral Analysis (ABA) can result in dramatic improvements for children with ASD. ABA employs methods based on the principles of learning theory, to increase or build socially useful skills and reduce problematic or dysfunctional behaviors.


In ABA, its treatment focuses on teaching small, measurable units of behavior systematically. Each step is taught in an one-on-one teaching situation with presentation of prompts or cues. Teaching trials are repeated many times, until the child performs a response readily without any prompts. All responses are recorded and evaluated according to the specific definitions and objectives set.


Along with ABA, other approaches (which still needs more research) to enhance and maximize skill development in children with ASD apart from the common Speech & Language therapy and Occupational therapy include the Denver Model(which is ABA-based), Social Communication, Emotional Regulation and Transactional Support or SCERTS, Relationship Development Intervention or RDI, Music therapy, DIR Floor Time, just to name a few.


Q: Is there any medication/vitamins/diets to cure ASD?

Various medical interventions, such as psychoactive drugs, hormone therapies, anti-yeast therapies and immunologic therapies, have been suggested in the treatment of ASD. However, the usage of these therapies is controversial and requires intensive research and conclusive evidence before it is to be given to ASD individuals. The use of psychotropic medication such as risperidon, have shown to reduce problem behaviour and may improve problem behaviour but not without side effects. Combining risperidone with parent training on behavioral interventions appears to improve outcomes (Aman et al., 2009).


Vitamin therapies have also been proposed in the treatment of ASD. Again, this therapy is not recommended as studies showed that its efficacy have mixed results. Although short-term side effects are reported to be mild, its side effects in the long time are not known.

The use of special diets that eliminates milk-products, gluten properties, or other specific foods from diets has been strongly advocated by some parties, with promising results. Diet therapies, however, are not generally accepted as the standard forms of treatment for autism, and is still considered experimental by many experts. Studies have not shown definite evidence and advantages to special elimination diets for ASD individuals, but limitations have been recorded, in which it may cause some children to get inadequate nutrition, besides being very costly.


Apart from the above, there have been no evidence for efficacy in treatments such as the anti-fungal & anti-yeast medication, Chelation Therapy, Craniosacral Therapy, Herbs and Homeopathic Treatments, Hyperbaric Oxygen Therapy, Iridology, Neurofeedback Therapy, Magnets or Secretin.


Q: What are the causes of ASD?

The cause of ASD is still unknown. However, it is known that there is a genetic component that puts some children susceptible to ASD. Studies have been conducted and some found that people with ASD have abnormal levels of serotonin or other neurotransmitters in the brain, while other studies found irregularities in several regions of the brain. While these findings are intriguing, further study needs to be carried out as they are still in the preliminary stages.


Q: What are the procedures in assessing a child suspected of having ASD?

To arrive with a formal diagnosis of ASD, the assessment involves experienced professionals gathering information about the particular child's behavior from parents and from direct observation of the child. An autistic assessment as well as a comprehensive assessment will be carried out, where the child is assessed in the following areas of development:


· Cognition

· Communication

· Social interactions and relationships

· Adaptive behaviours

· Motor skills

· Behaviour and responses to environment

· Relationship between family and child


Typical ASD assessment instruments are, Childhood Autism Rating Scale (CARS), and Gilliam Autism Rating Scale (GARS). A comprehensive health evaluation is also recommended to obtain a general health status of the child, as well as identifying other medical conditions that are sometimes confused with ASD, in a child who does not have ASD.

Q: How early can ASD be diagnosed?

As more studies are done on the area of ASD, there is an increasing ability to recognize this disorder at an early age. In many cases, a young child, even as young as under the age of three, can be identified and recognized by his/her difficulty in orienting to social stimuli, lack of social gaze, deficits in attention and motor imitation, and presentation of underdeveloped language abilities.


However, it is difficult to make a definite diagnosis at an early age with reliability, or ascertain whether the diagnosis will be accurate and predictive in a later diagnosis. Thorough and multiple observations are required, sometimes over an extended period of time, to confirm the diagnosis of ASD.


Q: Who can make the diagnosis?

Most of the time, symptoms of children with ASD are fairly apparent and noticeable by many others, it is important that qualified professionals are consulted to obtain a formal diagnosis. Professionals qualified to provide a formal diagnosis are:


· Psychiatrist

· Clinical Psychologist

· Pediatrician (will require to send child for referral to the above professionals)

· Doctors (will require to send child for referral to the above professionals)

Q: Is there a link between MMR and ASD?

Recent studies on the prevalence of autism have shown an increased in children afflicted with autistic disorder. And some studies have noted the increase correlates with the introduction of MMR vaccine given to children at about the age of 13 months to 18 months, which also coincides with some cases where some children later diagnosed to be autistic, appeared to have autistic-like symptoms and lose their language ability.


However, this issue is still in hot debate and controversial. Many specialists question the evidence and further studies are being done rigorously.

Q: Is there a prenatal test for Autism?

Currently, there is no genetic test for autism. However, prenatal biological test that investigates other medical conditions associated with autism, such as fragile X Syndrome and phenylketonuria, can be carried out.


Autism is not a choice, Acceptance is. It is not enough to be aware about ASD - Let's accept, support, respect and include!

In Collaboration with Early Intervention Programme (EIP) - http://www.eipautism.com/

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